Fragility of Red Blood Cells Collected Under Different Conditions With a Cell Saver Device

Abstract

Objective: To quantify the degree of lethal and sublethal damage to red blood cells (RBCs) by cell saver (CS) processing among different conditions of shed blood in cardiac surgery.

Design: Prospective randomized, double-blinded, controlled study.

Setting: Single university hospital.

Participants: Twenty rabbits were divided randomly into non-heparinized and heparinized groups. Thereafter, each group was subdivided into non-gauze and gauze groups based on whether the blood was collected with gauze and squeezed out.

Interventions: Blood from each group was aspirated directly from the heart and underwent CS processing. Mechanical fragility index (MFI) and percent hemolysis were measured pre- and post-CS processing.

Measurements and main results: In RBCs after CS processing, the MFI and percent hemolysis were increased significantly in both the non-heparinized and heparinized groups compared to pre-CS processing. The MFI was significantly higher in the heparinized group than in the non-heparinized group (p = 0.002). However, no differences in percent hemolysis were detected between groups (p = 0.696). The MFI and percent hemolysis of the non-gauze and gauze groups did not differ.

Conclusion: This study reports the increase in sublethal and lethal injuries to RBCs from heparinized and non-heparinized blood after CS processing. CS-processed heparinized blood contained more sublethally injured RBCs compared to CS-processed non-heparinized blood. RBCs collected by squeezing blood-saturated gauze did not exhibit additional trauma. Further investigation is required to determine the clinical implications of transfusing rescued but injured RBCs using a CS.

Keywords: blood cells; blood transfusion; hemolysis; operative blood cell salvage.